Utilization Management Nurse

Humana • Indianapolis, IN

1d • Remote

About The Position

Become a part of our caring community The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact

Requirements

• Active licensed Registered Nurse (RN) in the state of Virginia or obtain a multi-state license in a state that participates in the enhanced licensure, (eNLC) with no disciplinary action.
• At least 2 years prior utilization management experience preferably in an acute care skilled or rehabilitation clinical or healthplan/hospital setting
• Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment.
• Ability to work independently under general instructions and with a team strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills,
• Ability to work independently under general instructions and with a team

Nice To Haves

• BSN degree
• Experience with MCG/InterQual
• Health Plan experience, Medicare/Medicaid experience

Responsibilities

• Coordinates and communicates with providers to facilitate optimal care and treatment.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level